What Is the Value of Surgical Intervention for Sacral Metastases?

Abstract

ObjectiveTo investigate the impact of surgery on local control and quality of life for patients with sacral metastases and to determine whether the complications of surgery were acceptable.MethodsCurettage for metastatic lesions of the sacrum was performed in 154 patients with obvious sacral nerve compression symptoms between July 1997 and July 2014. Potential risk factors were evaluated in univariate analysis for associations with local control; multivariate conditional logistic regression was used to identify the combined effects. Complications were recorded. The pre- and postoperative visual analogue scale of pain, Eastern Cooperative Oncology Group (ECOG) scores, and quality of life scores were collected to evaluate the impact of surgery.ResultsThe cumulative survival rates were 71.8%, 41.1%, and 22.5% and the local control rates were 95.4%, 90.9%, and 79.4% at 6, 12, and 24 months, respectively. Tumors with rapid growth, the lack of preoperative radiotherapy, and application of aortic balloon occlusion were significantly associated with good local control. There were 29 (18.8%) complications related to surgery. The mean pain scores were 7.04 preoperatively, 1.66 at 1 month postoperatively (p = 0.003), and 1.51 at 3 months postoperatively (p = 0.002). The mean ECOG scores were 2.82 preoperatively and 1.47 3 months postoperatively (p < 0.001). There were significant improvements from preoperatively to 3 months postoperatively in global health status (43.3 vs. 52.1), pain (62.0 vs. 33.2), and constipation (51.4 vs. 30.3) (p < 0.001).ConclusionsSurgery for sacral metastasis is effective to palliate pain rapidly and improve constipation and quality of life and has a low rate of complications.

A Triple‐Classification Radiomics Model for the Differentiation of Primary Chordoma, Giant Cell Tumor, and Metastatic Tumor of Sacrum Based on T2‐Weighted and Contrast‐Enhanced T1‐Weighted MRI

“…Tumors of the sacrum, including primary and metastatic tumors, are rare . Sacral chordoma (SC), sacral giant cell tumor (SGCT), and sacral metastatic tumor (SMT) are the three most common sacrum tumors, accounting for approximately 75% of the total tumors . SC is the most common primary sacral tumor, accounting for approximately 40%, followed by SGCT .…”

Stereotactic body radiation therapy for spinal metastases: a novel local control stratification by spinal region

“…Local control rates may also be improved with surgical intervention prior to radiotherapy, which can downgrade epidural disease. 17,18,34,35 Even minimally invasive surgery in patients without spine instability, such as sacroplasty, may be of benefit. 38 Sacral tumors are often located close to major neural structures and involve complex anatomy, so establishing multidisciplinary care to individualize patient treatment plans is vital for optimizing outcomes.…”

“…Notably, two surgical studies pointed toward improved outcomes in patients with surgical intervention or surgery followed by adjuvant radiotherapy. 34,35 Only one dedicated study specifically considering the outcomes of cervical and sacral metastases after SBRT was identified, and it pointed toward improved local control in the cervical cohort and decreased local control in the sacral patients. 36 The purpose of this study was to consider a large, single-institution cohort and investigate predictive factors for local control, local progression-free survival (LPFS), overall survival, and pain response.…”

Palliative Radiotherapy as a Treatment for Carcinoma Invasion of the Sacrum: An Observational Case Series Study

“…Aggressive resection is utilized mainly for treating locally advanced CIS. However, this may compromise the stability of the sacroiliac articulation, threaten the neurological state of the lower body or cause intractable pelvic girdle pain (2,12). Evidently, there are serious concerns about these surgical complications.…”